Hepatitis B virus (HBV) reactivation is a common complication in chronic or resolved HBV
infection patients undergoing immunosuppressive
chemotherapy. Furthermore, few articles have been published regarding the risk of HBV reactivation in
lymphoma patients receiving
chimeric antigen receptor (CAR) T-cell therapy and anti-HBV prophylaxis. Few guidelines or clear optimal strategies are available for managing these patients. Here, we present two cases of patients who underwent CAR-T-cell cocktail
therapy with anti-CD19 and anti-CD22 CAR (CAR19/22) T cell for
lymphoma. Patients had previous history of HBV
infection, and blood tests on initial admission indicated positive results for
hepatitis B surface antigen (
HBsAg), antibody to
hepatitis B core antigen (anti-HBc), and antibody to
hepatitis B e antigen (anti-HBe), while serum HBV
DNA level was undetectable. Therefore, two patients received
entecavir as
antiviral prophylactic
therapy during their entire treatment. They were diagnosed with HBV reactivation based on positive serum HBV
DNA test results, 2 weeks after CAR-T-cell infusion. Liver function assay indicated elevated levels of
alanine transaminase (ALT) and
aspartate transaminase (AST), combined with increased levels of total
bilirubin (TBIL) and direct
bilirubin (DBIL). Subsequently, they received anti-HBV treatment with
entecavir and
tenofovir. As a result, their serum HBV
DNA copies and AST/ALT levels returned to normal after 1 week. These cases show that there is a risk of HBV reactivation in
lymphoma patients with CAR-T-cell therapy despite
entecavir preventive
therapy, and combination treatment of
entecavir and
tenofovir may be an effective treatment option for such patients with HBV reactivation.